Friday, May 01, 2009

The NHS - a sacred cow, or a dead one?

Delighted to say my latest article has been published on Training

Click here to read it

This is the full link


Anonymous said...

"I think the staff who work in the NHS have become accustomed to regular tampering with the way this gigantic institution is organised and structured.

Continuing improvements

in patient care

goes on

in spite of these changes

rather than

because of them."

Just think what would happen (doesn't it send excited chills up your spine at the thought) if everyone way out at the customer-meeting ends of the organization, when they had a mind to, was given full rein to try whatever they wanted to improve what they did in delivering the best possible service and outcome to each customer/client/patient.

And just think of the resources they would have with which to do it if every client/customer/patient did his or her level best to sleep well, eat well, work well and play well according to abilities and means.


Lois Gory

Trevor Gay said...

Lois - you are sooooooo right!!

If only we gave the people at the front line more power.

We are over managed in healthcare there is no doubt about that. We need to see a culture change to give the power to the folks doing the work at the front line rather than take that power to the committee rooms and warm comfortable offices.

Managers in healthcare are brilliant people too – there are just too many of them!

Thanks so much for your comments as always.

Best wishes


Dan Gunter said...

"All movement occurs as it is being inhibited." -- Humberto Maturana, creator of "Santiago's Theory of Cognition, and other theories that have since been applied to organizations and teams, recognizing them as more "biological" than "mechanical" in nature.

Or as I've heard Tom describe it (he may have been quoting someone, but I can't recall exactly):

"All great work is done in defiance of management."

Oversimplified? Maybe. But maybe not.

What say you, my friends?

Trevor Gay said...

Dan - the best way I ever heard it described was by Peter Drucker who said:

“Ninety percent of what we call ‘management’ consists of making it difficult for people to get things done.”

hucknjim said...


Okay you just knew I had to comment on this post. Here in the states Social Security is referred to as "the third rail of politics". Any politician who tampers with it is likely to get electrocuted: not the only reason Bush ended up being so reviled but I would venture to say a contributing factor. I guess we baby boomers still wield some power after all. So my question is, is the NHS the third rail of British politics? There's a subtle difference between tweaking and tampering.

As I'm sure you know, President Obama has proposed and is likely to get passed some form of government/private health insurance enacted in which health insurance is to be made affordable to everyone. As a "front line" worker in health care who knows our system is broken, I welcome this. I don't on the other hand see us ever adopting a system like the NHS. That would be political suicide or nearly so. So again I ask, do you see the NHS morphing into something like this model? It's been another long and busy day, and it's late so I hope this makes sense.


Trevor Gay said...

Hi John and thanks as always for your comments.

The NHS is definitely something politicians mess around with at their own peril. It is a vote loser to screw up healthcare. The NHS is regarded as very special by many people in the UK. I guess younger people will demand change in the future and I do see a day when there will be more private healthcare – simply because demand is increasing and supply is not able to keep up. I hope we will retain principles of free healthcare regardless of wealth and based on clinical need not ability to pay.

I think how a country treats the most frail members of society is a good yardstick on that country. I hope the UK retains a free NHS for as long as possible but I am a realist and one day I suspect we will see the NHS dismantled. Tweaking and tampering will not be enough - it will need radical surgery to make to affordable.

Dan Gunter said...


I can foresee the typical curve in all of this:

The majority of John Q. Public being excited over the plan for universal, affordable health care insurance. The President, et al, are considered heroes.

Then, shortly after the plan is implemented...

Inevitable "bugs" and "glitches" will surface. The President, et al get "demonized" by many for launching "the most abominable scheme ever devised."

Decades later...

The kinks get worked out and things are running smoother -- not necessarily perfect, but better than in the past. The President, et al, are seen by history as being "innovators" and "champions."

This seems to be the recurrent pattern in the course of U.S. history (and perhaps humankind in general.)

We all know access to affordable health care needs improving drastically. It would be nice to see someone finally step in and actually try to change the weather, instead of just telling us what we could walk outside and know for ourselves. I don't expect them to get it 100% right the first time, but future generations need OUR generation to start things moving.

hucknjim said...


While I agree with your thesis on the fact that health care needs to be reformed in the U.S. who are the people who are going to demonize it? The Republican party is so fractured that they are in danger of becoming a marginal political force. That leaves Rush Limbaugh and the rest of right wing talk radio and their compatriots on the blogosphere.

On the other hand, your point about glitches and the ultimate judgment of history is well taken. As a history enthusiast, I think there are only two presidents who were considered great in their time: Washington and Lincoln. And in Lincoln's case it had a lot to do with the fact that he was assassinated. So Obama will have to wait his turn. He will be ranked high just by virtue of being our first African American president. Ultimately though, he will be judged by how well his policies work to reform health care and the multitude of other issues he has taken on. I am hopeful. I wish him and my country well, and I have been involved long before Obama became a household name.


Dan Gunter said...


Historically, the opposing party has a propensity for highlighting all the shortcoming of any attempt by the President to implement change. Even if the criticisms amount to little more than political rhetoric, they utilize the media to put down every possible negative aspect of what may be a very well intended and overall functional plan.

The fact is that rarely does ANYTHING -- be it legislation, reform, a charitable cause, a business, anything -- have a perfect and flawless "roll out." It takes time, experience, flexibility, and hard work to fine tune anything. But in the case of government, most especially with party politics involved, there were be very loud voices screaming out how poorly designed the plan is. Whether they are in fact right or wrong in their opinion does not stop them from garnering a lot of attention and support for their opinion.

Over time, if things are adjusted and improving, the negative criticisms quieten down and eventually the critics shift from an attitude of "It's a bad idea in general" to one of "It's a great idea, we just need to figure out a better way to do it."

Personally, I'm all for affordable health care insurance for all Americans. But I am a realist, which means that if and when we try to implement something to provide it, I know it will have glitches to be worked out. I won't be so quick to call it a bad idea simply because it wasn't executed well. Far too many people get "ends" and "means" confused.

Trevor Gay said...

John and Dan – a fascinating exchange - thank you for sharing your views.

Interesting how history often looks upon leaders in a better light then contempories isn’t it?

I don’t know enough about your healthcare system in the States to make suggestions other than to say that tinkering and tweaking will not be enough. Just as we need radical reform in our government funded service so you need dramatic changes in view of increasing demand (for a multitude of reasons) and limited supply.

It has always been the case that demand outstrips supply in healthcare but I think demands are going to increase at a faster pace than previously as patients quite rightly demand more because they have far more information. This in turns puts pressure on an already stretched service. A political dilemma that all countries have to face.

During your election I was very impressed with Mr Obama and now as President I still feel he has the charisma and drive to make significant change. I wish him well with the battle to introduce some form of national health care system. I would love to be a part of the team involved in setting up such a system.

Dan Gunter said...


That makes at least two of us that would love to be part of such a team. Access to affordable health care is such an issue in this country, yet there are so many roadblocks. It will take tremendous courage and willingness to "stay the course" to actually accomplish it, that I don't think even two terms in the White House will come close to the amount of time needed to get a plan into effect.

I agree with you that tinkering would be a waste of time. And by and large the various individual state programs designed to make health insurance affordable for low income families are so varied in their mechanisms that trying to piece together what works from each in order to formulate a list of "best practices" would be a daunting task. Nonetheless, it would at least be a starting point in accomplishing something that has been little more than rhetoric on a national level.

This calls for putting in place massive changes, on a scale never before seen in the health care industry in this country. But no piecemeal efforts will work. It will be painful, but like getting a vaccination, the pain will go away and the long-term effects are vital to the well-being of this nation and its people as a whole.

As Tom likes to quote Nicholas Negroponte: "Incrementalism is innovation's worst enemy."

Trevor Gay said...

Agree with you Dan - as someone once said - 'All great journeys start with one small step"

I hope President Obama is bold with healthcare - history will record it as a turning point if your country goes for a national system.

I have always been taught we should be doing things for our children, their children and their children. We are after all only temporary guests on this planet – we do not own it.

Scott Peters said...


I like the responses with regard to the quotation on management (90%) and how this life is very much transitory in nature.

The polarization of the question is intriguing, but I believe NHS is a sacred cow. I've read enough (I believe) to understand that NHS has provided some much needed, and wonderful, care. I've also followed some posts by CLove and others that are relevant to critics taking shots at NHS.

Here's another fact for you...forgive me if I'm off a few rungs in the ranking.

United States
-Ranks 40th in healthcare across the globe.

-Ranks 1st in cost of the care.

Upon research, US copays (office visits) cost as much as some 3-4 day stays in English/European hospitals.

The debate could go on forever, and I conclude this: Healthcare will, and can always, improve! With that said, viruses, bacteria, and other microorganisms have equal rights to liberty and evolution. We should fear them more than we should NHS.

Congrats on the Carers again...and you have every right to a voice as you're looking to improve healthcare in your very country.

Trevor Gay said...

Hi Scott - good to hear from you as always.

The NHS has many critics and I am the biggest critic when it goes wrong for patients. However I am a great fan of the service as a universal system. It compares well with all universal systems on the planet. There is plenty of hard evidence to support that statement.

Clearly there are problems wit healthcare in the US – just as there are here and it is a political time bomb. It is not going to go away and politicians are going to have to sort it!

Family Carers (‘care givers’ in your country) need much more support – they save our country billions of pounds every year because they provide free care from a sense of love, obligation and duty.

Quite simply we would be bankrupt as a country without them.

Cheers Scott - keep smiling and thanks for your support.

hucknjim said...

Trevor and Dan,

I did not mean to suggest that health care reform in the U.S. will be easy. The fight and the hue and cry over this will make the battle about the budget and the economic stimulis package look like a minor school yard disagreement. On the other hand, Obama has a solid majority in both houses of congress. Will there be compromises? Of course. That is the nature of democracies. My point is that at least we will be able to make a stab at it. As Dan says, I don't care if it's imperfect. At least it's a first step which could lead to universal health care, however many years down the road that may be. What a great discussion this is. Good to be here.


Trevor Gay said...

I agree it’s a great discussion John and thank you for your excellent observations – the front line of healthcare is where most of the knowledge is Sir! - Well done!

I would dearly love to see your President take on the challenge head on. If a universal healthcare system emerged what a tremendous testimony that would be to him and his administration. It would be a magnificent and historic achievement.

I will be watching with great interest from this side of the pond and I hope you will keep me up to date with major news as President Obama leads the healthcare reforms.

John O'Leary said...

Cool topic. Geez, I've changed my mind so many times on how to fix health care in the US it's embarrassing. But from what I know of NHS - compared to my firsthand experience of the current US system - I'd do a swap in a New York minute.

My MAIN healthcare concern, however, which I'll blog about some day, is a US society that's overly and dangerously medicated. In my opinion, the illegal drug excesses of my youth pale in comparison to the legal drug excesses of today.

Dan Gunter said...


It's nice to know that at least YOU have had ideas (can't "change your mind" otherwise, can you?) It is a very tough question, though. Where do you start? Insurance coverage? Finance? Governance? Structure? Oversight? Standards? It is a complex critter, to be sure. And the solutions won't be easy to come up with, but we're sure not making any significant changes by doing nothing.

As for the over-medicating of America... I'm with you on that one. Western medicine is seriously lacking in the holistic approach that is more common in some other societies. Big pharmacy is big business and yields big power in the U.S. Come up with a new drug, market and advertise it like crazy, make tons of money, and hire lots of high powered lawyers to defend you when wrongful deaths and injuries occur. And while you're at it, you make sure that you have someone closely connected to you on the F.D.A. to give your drug that extra little "oomph" needed to get approval and sweep things under the rug when something bad happens.

I'm not against medications that actually improve the quality of life and treat conditions safely. But I am against using advertising and marketing to try and convince Americans that they must have some disease that you just happen to have a new "miracle drug" to treat.

I'm also more than convinced that we are grossly overdiagnosing ADD/ADHD in children in this country. Does the condition exist? I'm sure it does. But let a kid get a little antsy in school and fail to conform for a moment and he or she gets whisked off to the counselor, the school nurse, a pediatrician, and dragged into the pharmacy with mom or dad while they get the Ritalin Rx filled.

Too often, a kid just being a kid results in a kid being wrongfully medicated. Similar problems exist with antidepressants.

The best I've heard it described is that we have a THEORY that there MIGHT be some chemical imbalance in a person's brain. So, we load them up with some drug that is the very definition of CREATING a chemical imbalance in the brain.

You don't EVEN want to get me started on these matters. The internet might run out of blank pages if you do. :-(

Trevor Gay said...

John – good to hear from you my friend – I hope you are keeping well – hows the book coming along?

I know nothing about your US healthcare system so it’s unfair for me to be critical.

I do know about our NHS system in the UK. It has many warts and wrinkles as I always admit and I am the biggest critic when patient care goes badly wrong. However as I also always say I have yet to see EVIDENCE from any CREDIBLE report that there is a better UNIVERSAL system anywhere on our planet. The key word is universal. I have no doubt there are pockets of excellence in every country that will be superior to equivalent parts of our UK system but I await evidence of a better universal system.

You have experienced your own US service and you are therefore an expert in my view – patients are ALWAYS the real experts.

Trevor Gay said...

Dan – Was gonna respond with ‘keep takin the pills’ …. But maybe not :- )

Dan Gunter said...


Can't. The dude on the street corner didn't show up last night. Cold turkey. LOL.

John O'Leary said...

Dan: ditto, ditto, ditto, etc. We invent new medical conditions so we can prescribe drugs for them. Just a few hours ago I was listening to a psychotherapist bemoan the absurdity of trying to medicate ADD in children. Personally I stopped taking all pharmaceuticals (which I admit I abused in my rock & roll days) about 30 years ago. Haven't taken so much as an aspirin since. I believe 99% of our ailments can be alleviated or cured through non-pharmaceutical (and non-surgical) approaches, beginning with diet, but including exercise, meditation, etc. And I'm just one of a large and growing community of folks that have been living this way a LONG time.